Organizational health literacy in health care: Results from a participatory project in Germany

Abstract Background Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project “Development of Health Literacy in Health Care Facilities (EwiKo)’ aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities. Methods N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the “working groups on HL” filled in a self-assessment tool to assess the level of OHL, accompanied by focus group interviews (n = 6-9 persons per pilot facility). Regarding conducive and obstructive factors when implementing tools to strengthen OHL, focus group interviews (n = 6-9 persons per pilot facility) and semi-structured interviews (n = 1 coordinator per organization) were conducted. Results Results of the self-assessment tool showed a need to strengthen OHL in all types of health care facilities, particularly in the fields of action ‘training of employees in HL tools’, “communication” and ‘participatory development and testing of documents, materials and services on HL’. Results of the focus group interviews showed a special need to strengthen OHL in the area ‘HL of employees’. Beneficial factors by implementing tools to strengthen OHL are, for instance a supporting management, resources, a participatory approach and trainings by the project team. Conclusions Due to the ongoing corona pandemic and accompanying challenges (e.g., personnel resources), it is comprehensible that health care facilities emphasize a need for strengthening HL of employees.


Background:
Limited health literacy (LHL) is associated with faster kidney deterioration. To maintain kidney function, health care professionals (HCPs) promote self-management. However, in chronic kidney disease (CKD) care organizations, patients with LHL report multiple communication and self-management barriers. The need for health literacy responsive organizations, and multi-component interventions targeted at patients and HCPs, is recognized. We aimed to determine the objectives and strategies of such an intervention, and to co-create and evaluate it. Methods: First, we performed a longitudinal qualitative study among CKD patients with LHL (n = 24) and HCPs (n = 37) from general practices and nephrology clinics to assess needs and barriers, and to identify promising intervention objectives. Second, we included patients (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) in an Intervention Mapping (IM) process to co-create and evaluate the intervention.

Results:
Grip on Your Kidneys (GoYK) addresses the competences of patients with LHL to self-manage CKD on the long-term, and the communication competences of patients and HCPs. Based upon patients' preferences, GoYK encompasses a visually attractive website and brochures to optimize self-management and a card to contribute to consultations. With HCPs, we developed a training to optimize their competences to support patients with LHL. Evaluation revealed the intervention was useful, comprehensive and fitting needs.

Conclusions:
Mapping the needs of CKD patients and HCPs, combined with a process of intervention co-creation, resulted in a multicomponent, positively evaluated intervention. Implementation of this type of interventions in organizations is promising to improve care for patients with LHL. However, the effectiveness of these interventions requires further assessment.

Issue:
Healthcare organizations represent vital points of contact and disseminators for people to find, understand, assess, and apply health information, and may thereby strengthen people's health literacy (HL). From a system perspective, healthcare organizations provide essential practices and structures to foster population health beyond their medical-based services. Description of the problem: Despite increasing research on the promising role of organizational health literacy (OHL) the current Swiss healthcare system provides insufficient support for healthcare organizations to address HL. In response, the Careum Foundation in Zurich recently launched a Center for Health Literacy to promote OHL -among other HL initiatives. A first step was a practice-oriented collaboration project with the Department of Health of the canton of Zurich, which started in 2019 to assess, implement, and improve HL in primary care organizations. Therefore, a self-assessment tool for OHL is being developed, implemented, and evaluated. In addition, the center started to shed light on HL in Switzerland, on HL and necessary competencies of health professionals. Moreover, it is investing in communication and expertise on OHL, and developing first ideas regarding health literate hospitals.

Results:
A first systematic evaluation of the self-assessment tool has demonstrated a significant potential to improve OHL, organizational development, and teambuilding processes in healthcare organizations. Connected through (inter)national networks, the Center for Health Literacy launches a practice approach to understand OHL as both medium and outcome of a health literate population.

Lessons:
We have learned that practice-oriented OHL initiatives can provide promising approaches to strengthen both population health and organizational development processes.

Background:
Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project ''Development of Health Literacy in Health Care Facilities (EwiKo)' aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities. Methods: N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the ''working groups on HL'' filled in a selfassessment tool to assess the level of OHL, accompanied by focus group interviews (n = 6-9 persons per pilot facility). Regarding conducive and obstructive factors when implementing tools to strengthen OHL, focus group interviews (n = 6-9 persons per pilot facility) and semi-structured interviews (n = 1 coordinator per organization) were conducted.

Results:
Results of the self-assessment tool showed a need to strengthen OHL in all types of health care facilities, particularly in the fields of action 'training of employees in HL tools', ''communication'' and 'participatory development and testing of documents, materials and services on HL'. Results of the focus group interviews showed a special need to strengthen OHL in the area 'HL of employees'. Beneficial factors by implementing tools to strengthen OHL are, for instance a supporting management, resources, a participatory approach and trainings by the project team.

Conclusions:
Due to the ongoing corona pandemic and accompanying challenges (e.g., personnel resources), it is comprehensible that health care facilities emphasize a need for strengthening HL of employees. Currently, health systems worldwide are experiencing an unprecedented challenge after the shock caused by the COVID-19 pandemic. However, there lies an opportunity for renewal to strengthen health systems. The importance of collaboration becomes imperative in times of health workforce (HWF) shortages and demanding working conditions. This workshop, organised in partnership by the Young Forum Gastein and EUPHAnxt, will focus on connecting generations to explore, discover and share best practices for HWF education and (re)training in digital skills to deliver better patient care. The COVID-19 pandemic has accelerated digitalisation across many sectors including healthcare. Yet it has also served to highlight the digital divide, which has the potential to hinder health experts in providing optimal care. Concurrently, the demanding working conditions of the HWF can be improved by making use of digital tools. It is high time to discuss how digital literacy can be improved across a multigenerational HWF and how to empower the next generation of healthcare leaders to re-imagine health services. The workshop will bring different perspectives to the table -policy-making, science & academia, and governance -on the approaches for better intergenerational collaboration by making use of digital literacy. At the end of the session, participants will understand the realistic potential of digital literacy and how it can be used to ensure effective communication across the HWF, support the resilience of health systems, and ultimately, safeguarding patient care.

Key messages:
Digital literacy is not a stable level of knowledge -the health workforce needs opportunities to advance their knowledge and (digital) skills. Acknowledging the shortages in health workforce planning, it is essential to ensure adequate skills of the health workforce personnel. According to the latest data, in 2019 about 497,000 people were held in prison on any given day in the EU. However, the number of people who pass through European prisons each year is considerably higher. Due to infrastructural and population characteristics, individuals in contact with the criminal justice system face multiple and complex health care issues, including a higher prevalence of communicable diseases than the general population, and severe clinical outcomes when infected. The high turnover of people coming from the most disadvantaged segments of the population, together with the daily inflow/outflow of prison staff and facilities characterized by overcrowding, poor ventilation increase the risk of air-borne virus outbreaks. People living in prison are substantially more likely to experience drug-related problems than their peers in the community. Incarceration is associated with increases in blood-borne diseases-related risk behaviour among people who inject drugs. People living in prisons, 15th European Public Health Conference 2022